The Alliance for Quality Computed Tomography

Purpose

FDA Award

Questions

Role of the QMP

CT Dose-Check

Protocols

Lexicon

Education Slides

Statement of Purpose

The American Association of Physicists in Medicine (AAPM) is a professional organization whose members include board-certified medical physicists who specialize in the safe and effective use of radiation in medicine. Medical physicists partner with radiologists, technologists, regulators, manufacturers, administrators and others to ensure that CT scans are performed using the minimum amount of radiation required to obtain the diagnostic information for which the CT scan was ordered, or to guide the therapeutic procedure for which the CT is used.

In 2010, the Working Group on Standardization of CT Nomenclature and Protocols was formed to provide information to CT users that enhances the quality of their CT practice. The membership includes academic and consulting medical physicists who specialize in CT imaging, representatives of each of the major CT scanner manufacturers, and liaisons to the American College of Radiology, American Society of Radiology Technologists, and the Food and Drug Administration.

The Working Group was initially charged with the development of reference CT protocols, which are defined by the Working Group to be reasonable and appropriate protocols for specified diagnostic tasks. The published protocols provide typical clinical values for a sampling of currently available scanner models, and may not always match manufacturer-supplied reference protocols.

In addition to the development of reference protocols, the Working Group developed a lexicon to assist users in navigating the different nomenclature used by different manufacturers.

Since 2010, the Working Group has taken on a number of additional projects, including the development of recommendations and default values for CT Dose Alert and Notification Values, and the preparation of a number of teaching slide sets. Slides are available that describe the parameters on a CT scanner that affect the delivered dose; these include manufacturer-specific slide sets that show images of each manufacturer’s user interface. Additionally, slides have been developed that teach users about the Dose Check feature, and how to avoid potential problems that may occur in long interventional examinations.

It is our hope that you find the resources provided here to be helpful in achieving the highest level of quality in your CT practice.

American Association of Physicists in Medicine (AAPM) Working Group Recognized by the FDA

On June 10, 2013, the Director of the Center for Devices and Radiological Health (CDRH) of the Federal Drug Administration (FDA), Jeffrey Shuren, M.D., J.D., awarded the AAPM Working Group on Standardization of CT Nomenclature and Protocols the CDRH Director’s Special Citation Award. This award was presented “For developing CT imaging radiation safety instructional materials through a collaboration of end-users, CT manufacturers, and the Food and Drug Administration.”

The FDA award stated:

In 2010, FDA released an "Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging", which targets high dose imaging modalities, including CT. A key partner in following through on the goals of this Initiative has been the American Association of Physicists in Medicine (AAPM) Working Group on Standardization of CT Nomenclature and Protocols. Meeting bi-weekly since 2010, the group has worked tirelessly to advance CT radiation safety through publication of publicly available resources on the AAPM website (http://www.aapm.org/pubs/CTProtocols/).

The effect of these efforts has been to improve public health by optimizing the dose of ionizing radiation during CT scans and by helping to eliminate accidental radiation overdoses during CT scanning.

The group is an outstanding example of what can be accomplished through collaboration of key stakeholders. The group includes medical physicists, radiologists, radiologic technologists, industry representatives, and regulators, from AAPM, the American College of Radiology (ACR), the American Society of Radiologic Technologists (ASRT), the Society for Pediatric Radiology (SPR), the Image Gently Alliance, the Medical Imaging and Technology Alliance, from all 7 U.S. CT manufacturers, and from the FDA.

Additional Scanner Model Questions

Users with questions specific to a certain manufacturer or scanner model should contact the applications support line for that product. The AAPM cannot respond to requests for specific customer support.

Philips Healthcare:

Siemens Healthcare:

Toshiba Medical Systems:

Equipment Performance Questions

Users experiencing problems in performing an exam, or that have questions on the operation or performance of their systems, should contact their service provider. The AAPM cannot respond to requests for specific customer support.

Must be familiar with the principles of imaging physics and of radiation protection; the guidelines of the National Council on Radiation Protection and Measurements; laws and regulations pertaining to the performance of the equipment being tested; the function, clinical uses, and performance specifications of the imaging equipment; and calibration processes and limitations of the instruments used for performance testing.

The qualified medical physicist should be available for consultation regarding patient dosimetry issues.

The qualified medical physicist is responsible for the conduct of all surveys of the CT equipment.

A primary motivation of this working group is to support and equip AAPM members in the performance of these important duties. These materials are therefore being developed specifically for the medical physics community. Although many radiologists and technologists are well educated in the technical aspects of protocol development, there are some users who may have a difficult time in understanding and correctly implementing the provided information. We fundamentally believe that patients are best served when radiologists, technologists and medical physicists work together, each bringing their unique skill set and perspective to the task of protocol optimization. Radiologists and technologists desiring access to these protocols should contact the qualified medical physicist who supports their practice. Many practices have initiated protocol review teams to individually review each protocol in their practice. A qualified medical physicist is a necessary member of this team and can facilitate comparison of a site's existing protocols with those recommended here.

Computed Tomography Dose Check (NEMA XR-25) Education Slides

This section contains documents with information about CT Dose Notification and Alert values and how they can work in clinical practice. Dose Notification and Alert Values can be configured as part of a Dose Check feature described in NEMA XR-25. These documents also contain key points to ensure successful implementation of these features. These slides are intended for educational purposes and may be distributed freely with proper acknowledgement ("Courtesy of the AAPM Working Group on CT Nomenclature and Protocols").

Pediatric Protocols

Your feedback regarding the content of this website is welcome. Feedback regarding this website will not be monitored daily. Users experiencing problems in performing an exam should contact their service provider.

DISCLAIMER

I Disagree

I Agree

CT scan parameters: Translation of terms for different manufacturers

Introduction

For the CT technologist who operates multiple scanner models, perhaps from multiple manufacturers, the variability in names for important scan acquisition and reconstruction parameters can lead to confusion, reduced comfort and an increased potential for error. The intent of this CT terminology lexicon is to allow users to translate important CT acquisition and reconstruction terms between different manufacturers' systems.

This represents a first step in the terminology standardization effort undertaken by this working group. Phase 2 of our work will:

Identify relevant terms from established standard lexicons (e.g. RadLex and DICOM) and other relevant literature and publish an expanded lexicon including these terms.

Form consensus recommendations on preferred terms.

This website will be updated as the terminology standardization work progresses.

The generic descriptions or terms in the first column are intended to orient the user to the relevant concepts; they are not consensus "preferred terms." The generic descriptions are not based on any single existing or pending terminology standard; however the references in the pdf attachment were consulted in developing the generic descriptions. Future efforts of this Working Group include making recommendations for standardized terminology.

A number of individuals and groups have advocated for terminology standardization in CT, including at a March 30-31, 2010 FDA public meeting entitled "Device Improvements to Reduce Unnecessary Radiation Exposure from Medical Imaging" (transcripts available here; see p. 153-155). Participants proposed a cooperative effort among professional organizations (AAPM, ASRT, ACR, etc.), industry, FDA, and standards organizations to accomplish this task, as is now being undertaken by this Working Group.

Computed Tomography Radiation Dose Education Slides

This section contains documents with information on how CT acquisition parameters and CT scanner features affect the radiation dose used for a given study and how the dose is reported and tracked. These slides are intended for educational purposes and may be distributed freely with proper acknowledgement ("Courtesy of the AAPM Working Group on CT Nomenclature and Protocols").

The "General Dose Education Slides" are available as a PowerPoint or PDF file and contains vendor-independent information on CT acquisition parameters, dose modulation and reduction and dose display. The entire slide set or pieces of it may be incorporated into any educational presentation as the user sees fit.

The Power Point slides that are accessible through the following link deal with factors that affect radiation dose in CT studies. They may be used as a resource for developing presentations on this topic.

General Dose Education Slides

The "Vendor Dose Education Slides" are available as PDF files only and individual slides may not be modified by the user. Each slide set follows the same outline as the General Dose Education Slides but includes vendor-specific screen shots and information on vendor specific parameters and features. The vendor specific slides were generated with the assistance of the vendor and screen shots of the scanner console/interface and descriptions of the vendor specific acquisition parameters are not representative of all scanners and software versions produced by the vendor. The slides are for instructional purposes only.

AAPM is a scientific, educational, and professional nonprofit organization devoted to the discipline of physics in medicine. The information provided in this website is offered for the benefit of its members and the general public, however, AAPM does not independently verify or substantiate the information provided on other websites that may be linked to this site.